POS1201-HPR ADVANCED PRACTICE RHEUMATOLOGY NURSING FOR PATIENTS WITH GOUT TARGETS URATE, KNOWLEDGE, AND LIFESTYLE TO ENHANCE CHRONIC DISEASE OUTCOME
Authors: M. O’neill, D. Veale, E. Molloy, C. Orr, P. Minnock
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Gout is the most common chronic inflammatory arthritis worldwide and the only curable. Yet, gout care remains suboptimal despite evidence of the benefits of a treat-to-target approach to normalise urate levels. The efficacy and cost effectiveness of nurse led care in this treat-to-target strategy has been well recognised (Fuller, 2020) <h3>Objectives:</h3> To implement a patient centred treat-to-target urate lowering strategy within a holistic health promotion, secondary prevention model of advanced practice nursing. To engage, raise awareness and educate patients about: i) the short and long-term health implications of hyperuricaemia and ii) the merits of self-management strategies to improve their health outcome <h3>Methods</h3> With stakeholder agreement a gout clinic was established. The Making Every Contact Count (MECC) framework was used to implement the treat-to-target approach per the EULAR (European Alliance of Associations for Rheumatology) recommendations for the management of gout. Making every contact count, grounded in a behavioural change approach, promotes brief intervention therapy to support lifestyle behaviour change to make each routine contact with patients count in terms of chronic disease healtcare (Meade, 2022: Gwinnutt, 2023). The 12-question Gout Self-Management Knowledge Questionnaire was completed at baseline, followed by a nursing educational intervention through a planned gout programme and repeated at final visit (Fields, 2017). <h3>Results</h3> To date 102 patients have attended the clinic. Baseline and final clinic assessments are available for 42 patients. The number of clinic reviews per patient was 6. Thirty-five (83%) were male; mean age was 61 years (range 29-91); mean disease duration was 9 years (range 1-40). The mean time to diagnosis from symptom onset was 4 years (range 0-29). At baseline, 17 (40%) reported a family history and past experience of a urate-lowering therapy. The reported mean number of flares per-annum was 1-2 (n=20); 3-5 (n=17); &gt;6 (n=5); 20 patients (48%) had podagra; 14 patients (33%) had tophi. Urate levels improved by 76%, falling from a baseline of 397 µmol/L to 301 µmol/L at final visit; an 83% improvement was seen in the Gout Self-Management Knowledge Questionnaire. The subjective numeric global health score (0-10, where 10 represents worst health status) showed a median score of 1.5 at baseline and 1 at final visit. <h3>Conclusion</h3> Findings demonstrated 1) normalisation of urate to target levels, 2) an improvement in patients' insight and 3) a parallel upgrading in patients reported global health score. <h3>References</h3> [1] Fuller, A., Jenkins, W., Doherty, M. and Abhishek, A., 2020. Nurse-led care is preferred over GP-led care of gout and improves gout outcomes: results of Nottingham Gout Treatment Trial follow-up study. <i>Rheumatology</i>, <i>59</i>(3), pp.575-579. [2] Meade, O., O'Brien, M., Mc Sharry, J., Lawless, A., Coughlan, S., Hart, J., Hayes, C., Keyworth, C., Lavoie, K.L., Murphy, A.W. and Murphy, P., 2022. Enhancing the implementation of the Making Every Contact Count brief behavioural intervention programme in Ireland: protocol for the Making MECC Work research programme. <i>HRB Open Research</i>, <i>5</i>. [3] Gwinnutt, J.M., Wieczorek, M., Balanescu, A., Bischoff-Ferrari, H.A., Boonen, A., Cavalli, G., De Souza, S., De Thurah, A., Dorner, T.E., Moe, R.H. and Putrik, P., 2023. 2021 EULAR recommendations regarding lifestyle behaviours and work participation to prevent progression of rheumatic and musculoskeletal diseases. <i>Annals of the rheumatic diseases</i>, <i>82</i>(1), pp.48-56. [4] Fields, T.R., Rifaat, A., Yee, A.M., Ashany, D., Kim, K., Tobin, M., Oliva, N., Fields, K., Richey, M., Kasturi, S. and Batterman, A., 2017, April. Pilot study of a multidisciplinary gout patient education and monitoring program. In <i>Seminars in arthritis and rheumatism</i> (Vol. 46, No. 5, pp. 601-608). WB Saunders. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Madeline O'Neill: None declared, Douglas Veale Shareholder of: Health Beacon, Speakers bureau: AbbVie, BMS, Celgene, Galapagos, Gilead, Janssen, MSD, Pfizer, UCB, Paid instructor for: Consultant/Advisor: AbbVie, Actelion, BMS, Galapagos, Gilead, Janssen, MSD, Pfizer, UCB, Regeneron/Sanofi, Novartis, Grant/research support from: AbbVie, Amgen, Boehringer Ingelheim, BMS, Eli Lilly, Novartis Janssen, Pfizer, UCB, MSD, Eamonn Molloy: None declared, Carl Orr Speakers bureau: AbbVie, Patricia Minnock: None declared.